Individual
MAGDALENE KIDD VASCONEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
58646 MCNULTY WAY, SAINT HELENS, OR 97051-6210
(912) 755-0906
Mailing address
58646 MCNULTY WAY, SAINT HELENS, OR 97051-6210
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW007219
GA
1041C0700X
Clinical Social Worker
L15511
OR
Other
Enumeration date
11/21/2020
Last updated
11/25/2025
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